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About 20% of women from a variety of different ancestry have a high hairline, and it is often a major reason for self-consciousness. Since having a big forehead, or a high hairline is typically considered a masculine trait, it is understandable why a female patient would be concerned about this. Some women with a 'large forehead' feel that it makes them look older as well. An ideal feminine hairline is supposed to be within the range of 5-6.5 cm above the eyebrows, whereas a masculine hairline is typically 6-8 cm above the brows.

Recently, a study was conducted to see if the induction of an Endotine device during hairline lowering surgery would help make the hairline density thicker. The study was performed in Oakland, California at the aesthetic facial plastic surgery center under Dr. Sheldon Kabaker. All patients that were undergoing the surgery between October 2015 and April 2016 (with their permission) were included in the study.

Patients considering this surgery are often concerned about hair thinning. A way to combat hair thinning is the insertion of a tiny, dissolving device, called an Endotine. It anchors the scalp on the skull close (within 3 cm) to the hairline. It takes stress and strain off the closure. It also squeezes the hair in the front instead of stretching it. Although this most likely causes a greater amount of stretching of the scalp behind, this stretching is spread over the scalp behind for 25-30 more centimeters.

In the study, the patient's hair density was measured prior to the Endotine insertion and after the Endotine insertion and closure of the hairline. The hair density was measured in two separate locations, the hairline and the vertex of the scalp. The findings of the study were that hair density increased after the operation, in comparison to the hair density prior to the Endotine insertion. The postoperative density at the hairline zone increased as well. So, use of Endotine in surgical forehead reducation preserves or improves the hairline density for patients. The findings from this study were shared with the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) at the Spring meeting in Chicago in May 2016.

Patients that complain about having a large forehead are often good candidates for forehead reducation surgery, as it provides unmistakable, quick results. There are two options, depending on the patients wants, needs, and the size of their scalp. One-stage hairline lowering brings the hairline down about an inch. For patients who have a very tight scalp or want a greater advancement, a two-step procedure can be performed. In the first stage, small balloon-like devices are inserted in the scalp, and over six to eight weeks, the balloons are slowly inflated. The scalp can be lowered as much as desired; as much as 10 cm in one case.

Dr. Kabaker has been performing surgery with the Endotine for 12 years, and practicing comparable surgical procedures for 40 years. He has successfully performed over 400 hairline reduction surgeries, and is considered by many to be an expert on the subject. His findings have been published online, in textbooks, Wikipedia, and in medical journals alike.